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What Arizona’s Tenuous Coronavirus Plateau Could Teach Us

As the United States surpasses four million known coronavirus cases, far more than any other country, new outbreaks are sending thousands of seriously ill people to hospitals and driving a new wave of funerals. But there are also initial signs that new infections may be leveling off in some places, including in some of the worst hot spots.

That may be most visible in Arizona.

Only a few weeks ago, Arizona was leading the nation in coronavirus infections per capita, as the virus spread across many Sun Belt states that had opened quickly in late spring. Facing a mounting crisis in June, Gov. Doug Ducey, a Republican, reversed himself and allowed cities and counties to order residents to wear masks. He also rolled back some earlier reopenings, and directed bars, indoor gyms, water parks and movie theaters to shut down again.

About a month later, the number of patients hospitalized with the virus is starting to decline. As of Friday afternoon, Arizona was the only state where known new daily cases were decreasing, a milestone that reflected, in part, just how dire conditions had been.

“It is possible in the course of a month to begin to really turn things around. We saw that in March and April,” said Dr. Tom Inglesby, the director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

The question now is whether it is possible to do so while avoiding another full lockdown, and states like Arizona are offering a real-time experiment.

“In some ways, it is like a large-scale version of a clinical trial,” Dr. Inglesby said. “Arizona is one of the states involved and is going through crisis and now is taking a certain set of interventions, and we are seeing if those interventions work.”

ImageFacing a mounting crisis in June, Gov. Doug Ducey of Arizona reversed himself and allowed cities and counties to order residents to wear masks. 
Credit…Pool photo by Matt York

Arizona has often been mentioned in the same breath as Florida and Texas, after all three states experienced alarming rates of growth this summer, driving the worst of the outbreak in the Sun Belt. The states are each led by a Republican governor who issued stay-at-home orders in the spring, and who resisted shutting back down completely when the virus later arrived in full force. Instead, the states took a targeted approach, pairing limitations on bars with mask requirements, either locally or statewide.

Texas and Florida are also seeing slight signs of improvement, though each is averaging more than 9,000 new confirmed cases a day and both have hot spots that have high rates of hospitalization.

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Updated 2020-07-25T09:43:39.358Z

Arizona is now averaging 2,600 new cases a day, down from 3,800 earlier this month. The number of new cases can depend on testing, an issue Arizona has struggled with, but the number of people hospitalized with the virus — a real-time measure of who is seriously sick — has also started to decline. Arizona had 2,844 people who tested positive or who were suspected of having Covid-19 hospitalized on Thursday, about an 11 percent decline from mid-July. (The state does not release local data on hospitalizations, so it was unclear how stressed hospitals were in metro areas like Phoenix.)

Arizona is still leading the nation in deaths per capita, which are seen as a lagging indicator of the current state of the virus, but nevertheless offer a stark reminder of the devastation brought on the state after a swift reopening. Cases are now plateauing at a level much higher than when Arizona initially shut down in March, and the number of people on ventilators on Thursday, 575, was down from a high of 687 a week earlier.

“We’ve stabilized at 95 miles an hour, and that is not the speed that we want to be going,” said Dr. Joshua LaBaer, director of the Biodesign Institute at Arizona State University. “Ideally, we don’t want this car moving at all.”

Credit…Matt York/Associated Press

Big problems persist for researchers trying to piece together more precisely how the virus is spreading in Arizona, including the lag times in the reporting of coronavirus cases and in confirming test results. Sonora Quest, one of the state’s largest labs, disclosed on Thursday that it had about 55,000 tests that had not been processed, and that it was taking between nine and 12 days to obtain most results, far longer than the 24-hour turnaround time public health experts recommend.

Arizona has a relatively high positive test rate, a key measure of both the spread of the virus and the effectiveness of the state’s response. High positive test rates can indicate insufficient testing, experts say.

Even so, disease specialists say Arizona is getting some things right. Dr. LaBaer noted that Governor Ducey changed his tone on prevention efforts and began wearing a mask in public.

Geography may also play a role. About 5.5 million of Arizona’s seven million residents — about three in four people — live in Maricopa County, which includes Phoenix, and Pima County, which includes Tucson. Both issued orders requiring face masks a little more than a month ago, in mid-June.

The Navajo Nation, hit by severe outbreaks in March and April, has also vigorously introduced measures such as mask mandates, checkpoints and curfews. The reservation, which spreads over parts of Arizona, New Mexico and Utah, has reported fewer than 50 new cases a day over the past week, compared with more than 170 a day a few weeks ago.

With prevention efforts on the rise, the vast majority of Arizonans have been living with mask mandates and more shutdowns for about a month, about the time experts say it takes to start seeing the effect of new policies.

By contrast, many of Florida’s 21 million residents are spread out across big and midsize cities, with overlapping city and county governments. With mask orders in place in many of the largest counties, and with a statewide limit on bars since late June, the state has shown some small declines in new cases in recent days for an average of 10,000 cases a day, down from 11,800 last week.

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In Texas, whose 29 million residents are spread across 254 counties, Gov. Greg Abbott shut down bars in late June and issued a statewide mask requirement about three weeks ago. The state is now averaging more than 9,000 cases a day, down from more than 10,000 a few days ago. In Houston, officials are seeing reason for hope amid a slight drop in hospitalizations, even as the virus has overwhelmed hospitals in other parts of Texas, including the border region known as the Rio Grande Valley.

“We are cautiously optimistic that we’re seeing a leveling off,” said Catherine Troisi, an infectious-disease epidemiologist at UTHealth School of Public Health in Houston, who said the combination of measures seemed to be working.

But she cautioned that it may be too early to tell how significantly the intermediate measures had stopped the spread. “Is the best we can do plateauing, or can we actually start to see a decrease?” she said. A lot of that is dependent on individual behavior.”

Credit…Cassidy Araiza for The New York Times

Trish Riley, executive director of the National Academy for State Health Policy, said she had seen some Sun Belt states using lessons learned from the Northeast, which generally shut down quickly in the spring and took a slower, targeted approach to reopening. In many places in the Sun Belt, it has been the opposite: slow to shut down, quick to reopen and, now, a targeted approach to scaling back again.

One notable outlier is California, which was the first state to issue a stay-at-home order and where a spring lockdown lasted longer than those in many other states. But after keeping the state closed through late May, Gov. Gavin Newsom, a Democrat, faced increasing pressure and ceded much of the decision-making to local officials, leading to a ramped-up reopening. The state is now experiencing a surge of new infections and recently surpassed New York in having the most cases of any state.

“This disease is so profoundly challenging to predict,” Ms. Riley said, citing California as an example. “It’s really challenging.”

For Arizona to go beyond leveling off new cases to bring the virus under control, the actions of businesses like the Greenwood Brewing in downtown Phoenix, and their patrons, remain crucial. On Friday, signs at every entrance to the brewery instructed people to wear masks in compliance with Phoenix’s citywide mandate.

Megan Greenwood, the brewery’s founder, said that her staff had masks behind the bar to give to people who walked in without one, but that, so far, they had not been necessary.

“We haven’t actually had to give anybody a mask,” Ms. Greenwood said. “We haven’t even had people going to the bathroom without their mask on. They know that masks are required.”

Lauren Messman contributed reporting.


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